Criterios de medicación potencialmente inapropiada para el anciano: una propuesta cubana / Medication approaches potentially inappropriate for the elderly: a Cuban proposal

Introducción: El impacto de la prescripción inapropiada de fármacos en el anciano ha llevado al desarrollo de métodos para su reducción en varias partes del mundo. Objetivo: Diseñar y validar los criterios de medicación potencialmente inapropiada en el anciano, adaptados al entorno sociosanitario de Cuba. Métodos: Se realizó una investigación cualitativa, en la cual los criterios fueron validados por medio de la metodología Delphi, por un comité de expertos (especialistas en medicina geriátrica y clínica de diferentes zonas geográficas del país), y se les calculó la consistencia interna mediante el coeficiente alfa de Cronbach. Resultados: Los criterios quedaron estructurados en tres listas: 1) medicación potencialmente inapropiada, medicamento indicado no prescripto, cuando no existe contraindicación para su uso; 2) medicación potencialmente inapropiada independiente del diagnóstico o la condición clínica; 3) medicación potencialmente inapropiada dependiente del diagnóstico o la condición clínica. Conclusiones: Se demostró la validez del contenido y la adecuada consistencia interna de los criterios diseñados para la identificación de medicación potencialmente inapropiada en el anciano.

Introduction: The impact of inappropriate prescription of medication in the elderly has led to the development of methods for its reduction in several parts of the world. Objective: To design and validate the medication approaches potentially inappropriate in the elderly, adapted to the socio-sanitary environment of Cuba. Methods: A qualitative investigation was carried out, in which the approaches were validated by means of the Delphi methodology, by an experts committee (specialists in geriatrics medicine and clinic from different geographical areas of the country), and the internal consistency was calculated by means of the alpha coefficient of Cronbach. Results: The approaches were structured in three lists: 1) potentially inappropriate medication, advised medication non prescribed, when contraindication doesn't exist for its use; 2) medication potentially inappropriate, independent from the diagnosis or clinical condition; 3) potentially inappropriate medication, depending on the diagnosis or clinical condition. Conclusions: The validity of the content and the appropriate internal consistency of the designed approaches for the medication identification potentially inappropriate in the elderly were demonstrated.

Content design and validation of a Standard Operating Procedure to provide pharmacotherapy follow-up for the elderly in Cuba

ABSTRACT Incorporating methodological tools that allow uniform and standardized development from the clinical pharmacy services to the Pharmaceutical Care practice, is nowadays a necessity. Considering the importance of pharmaceutical care provision to elderly patients, this manuscript introduces the design and content validation of a standard operating procedure to provide pharmacotherapy follow-up to the elderly in nursing homes in Cuba. The procedure was designed based on a deep analysis of documents relative to experiences focused on holistic care to elderly patients, criteria for the identification and assessment of potentially inappropriate prescriptions and the relationship between functional geriatric evaluation and the use of drugs. The content validation was conducted by a panel of experts, using the Delphi methodology, through two working sessions. In addition, we used Likert-type scale to evaluate the procedure by experts, in line with the indicators described. In general, the criteria issued by the experts were very appropriate and allowed us to modify, add or keep several elements of the instrument for the final version. The findings demonstrated that the instrument can be used at any level of health care.

What is the role of the pharmacist?: physicians' and nurses' perspectives in community and hospital settings of Santiago de Cuba

This study was carried out to understand the perceptions and expectations of the other health care professionals about pharmacists' role in primary health care centers and hospitals in Santiago de Cuba (Cuba). A cross-sectional descriptive study was conducted, applying a self-administered questionnaire to health care professionals. The sample included 763 professionals (40.9 percent physicians and 59.1 percent nurses) from hospitals and primary health care clinics, chosen by random stratified sampling,. The most common activity performed by pharmacists was the distribution of medications or the drug supply management (51.5 percent) and adverse drug reactions reporting (29.4 percent), activities performed daily by pharmacists. Pharmaceutical care practice was considered as poor by the professionals, and only 15.6 percent of them have collaborated in these programs in the past. For nurses and physicians, interprofessional communication occurs sometimes (56.9 percent) and never (25.8 percent). Pharmacists' integration into the health team was considered as fair (50.7 percent). A total of 70.1 percent perceived the pharmacist as a drug expert and 60.1 percent as a professional who provides medication counseling. The main expectations these health care professionals expressed were that pharmacists provide more education about medication (97.4 percent) and improve their interprofessional communication techniques in order to communicate more effectively with the other members of the health care team (96.6 percent).

O presente trabalho analisa o papel do farmacêutico na atenção primária de saúde e em hospitais, na percepção de profissionais da saúde na província de Santiago de Cuba. Um estudo descritivo transversal foi conduzido, através da aplicação de um questionário autoadministrado a uma amostra de 763 profissionais de atenção primária e hospitalar, 40,9 por cento de médicos e 59,1 por cento de enfermeiros. As funções farmacêuticas mais reconhecidas pelos profissionais desta amostra foram o fornecimento e distribuição de medicamentos (51,5 por cento) e o relato de reações adversas medicamentosas (29,4 por cento), funções desenvolvidas diariamente. A prática da atenção farmacêutica é limitada na percepção dos profissionais e apenas 15,6 por cento têm participado em programas desse tipo. Comunicação interprofissional ocorre às vezes (56,9 por cento) e nunca (25,8 por cento), com maiores dificuldades na atenção primária de saúde. A integração do farmacêutico na equipe de saúde foi considerada regular (50,7 por cento). Um total de 70,1 por cento dos profissionais percebeu o farmacêutico como especialista em medicamentos e 64,1 por cento como o profissional que aconselha sobre o uso de medicamentos. As principais expectativas colocam-se na necessidade de que o farmacêutico ofereça educação sobre o uso de medicamentos (97,4 por cento) e reforce as suas técnicas da comunicação na equipe multidisciplinar (96,6 por cento).